The distance between the tibial tunnel aperture and meniscal root attachment is correlated with meniscal healing status following transtibial pullout repair for medial meniscus posterior root tear

Background: To investigate the relationship between tibial tunnel aperture location and postoperative meniscal healing. Methods: We enrolled 25 patients (20 women and five men, mean age: 62.5 years) who underwent transtibial pullout repair for medial meniscus (MM) posterior root repair. The expected MM posterior root attachment center (AC) and tibial tunnel center (TC) were identified using three-dimensional computed tomography, and the minimum AC–TC distance was calculated. The meniscal healing status following transtibial pullout repair was assessed by second-look arthroscopy (mean postoperative period: 15 months) using a previously reported scoring system (meniscal healing score; range: 0–10). The association between AC–TC distance and meniscal healing score was investigated using univariate linear regression models. The optimal AC–TC distance cut-off for improved MM healing score (≥ 7) was determined using receiver operating characteristic analysis. Results: The AC–TC distance and meniscal healing score were significantly associated (y = − 0.42x + 9.48, R² = 0.342; P = 0.002), with the optimum AC–TC distance being 5.8 mm. This cut-off had a sensitivity of 100% and specificity of 53%. Conclusions: This study demonstrates that AC–TC distance is significantly correlated with postoperative meniscal healing. Anatomical repair within 5.8 mm of the AC may result in improved meniscal healing.